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Abatacept as a successful therapy for myositis—a case-based review

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Abstract

Only limited evidence exists on the therapeutic potential of biologic agents in the treatment of myositis. We present a brief review of the literature on off-label experiences of biologic agents in myositis, with a special interest in abatacept. Rituximab has been indicated to be beneficial and well tolerated in one large randomized controlled trial and many smaller studies. Initial data on tumour necrosis factor (TNF) inhibitors are conflicting. There are only a few case reports and mechanistic studies on the treatment of myositis with other biologics, including alemtuzumab, anakinra, tocilizumab and abatacept. We report a patient with severe myositis overlap syndrome, manifesting also as rheumatoid arthritis, peripheral vasculitis and interstitial lung disease. Her myositis was refractory to many conventional and biologic therapies but was well controlled with abatacept. This suggests that abatacept might be a beneficial option for the treatment of refractory myositis and that clinical trials are needed to further investigate its efficacy.

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References

  1. Aggarwal R, Oddis CV (2012) Therapeutic advances in myositis. Curr Opin Rheumatol 24:635–641

    Article  CAS  PubMed  Google Scholar 

  2. Carstens PO, Schmidt J (2013) Diagnosis, pathogenesis and treatment of myositis: recent advances. Clin Exp Immunol.

  3. Gordon PA, Winer JB, Hoogendijk JE, Choy EH (2012) Immunosuppressant and immunomodulatory treatment for dermatomyositis and polymyositis. Cochrane Database Syst Rev 8:CD003643

    Google Scholar 

  4. Couderc M, Gottenberg JE, Mariette X et al (2011) Efficacy and safety of rituximab in the treatment of refractory inflammatory myopathies in adults: results from the AIR registry. Rheumatology (Oxford) 50:2283–2289

    Article  CAS  Google Scholar 

  5. Majmudar S, Hall HA, Zimmermann B (2009) Treatment of adult inflammatory myositis with rituximab: an emerging therapy for refractory patients. J Clin Rheumatol 15:338–340

    Article  PubMed  Google Scholar 

  6. Garcia-Hernandez FJ, Gonzalez-Leon R, Castillo-Palma MJ, Sanchez-Roman J (2011) Rituximab is effective in the treatment of patients with idiopathic inflammatory myopathy. Clin Exp Rheumatol 29:363–364

    CAS  PubMed  Google Scholar 

  7. Basnayake C, Cash K, Blumbergs P, Limaye V (2013) Use of rituximab in histologically confirmed idiopathic inflammatory myositis: a case series. Clin Rheumatol.

  8. Munoz-Beamud F, Isenberg DA (2013) Rituximab as an effective alternative therapy in refractory idiopathic inflammatory myopathies. Clin Exp Rheumatol 31:896–903

    PubMed  Google Scholar 

  9. Oddis CV, Reed AM, Aggarwal R et al (2013) Rituximab in the treatment of refractory adult and juvenile dermatomyositis and adult polymyositis: a randomized, placebo-phase trial. Arthritis Rheum 65:314–324

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Muscle Study Group (2011) A randomized, pilot trial of etanercept in dermatomyositis. Ann Neurol 70:427–436

    Article  Google Scholar 

  11. Efthimiou P, Schwartzman S, Kagen LJ (2006) Possible role for tumour necrosis factor inhibitors in the treatment of resistant dermatomyositis and polymyositis: a retrospective study of eight patients. Ann Rheum Dis 65:1233–1236

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Anandacoomarasamy A, Howe G, Manolios N (2005) Advanced refractory polymyositis responding to infliximab. Rheumatology (Oxford) 44:562–563

    Article  CAS  Google Scholar 

  13. Hengstman GJ, van den Hoogen FH, Barrera P et al (2003) Successful treatment of dermatomyositis and polymyositis with anti-tumor-necrosis-factor-alpha: preliminary observations. Eur Neurol 50:10–15

    Article  CAS  PubMed  Google Scholar 

  14. Dastmalchi M, Grundtman C, Alexanderson H et al (2008) A high incidence of disease flares in an open pilot study of infliximab in patients with refractory inflammatory myopathies. Ann Rheum Dis 67:1670–1677

    Article  CAS  PubMed  Google Scholar 

  15. Iannone F, Scioscia C, Falappone PC, Covelli M, Lapadula G (2006) Use of etanercept in the treatment of dermatomyositis: a case series. J Rheumatol 33:1802–1804

    CAS  PubMed  Google Scholar 

  16. Lazarou IN, Guerne PA (2013) Classification, diagnosis, and management of idiopathic inflammatory myopathies. J Rheumatol 40:550–564

    Article  CAS  PubMed  Google Scholar 

  17. Dalakas MC, Rakocevic G, Schmidt J et al (2009) Effect of alemtuzumab (CAMPATH 1-H) in patients with inclusion-body myositis. Brain 132:1536–1544

    Article  PubMed Central  PubMed  Google Scholar 

  18. Zong M, Dorph C, Dastmalchi M et al. (2013) Anakinra treatment in patients with refractory inflammatory myopathies and possible predictive response biomarkers: a mechanistic study with 12 months follow-up. Ann Rheum Dis.

  19. Okiyama N, Sugihara T, Iwakura Y, Yokozeki H, Miyasaka N, Kohsaka H (2009) Therapeutic effects of interleukin-6 blockade in a murine model of polymyositis that does not require interleukin-17A. Arthritis Rheum 60:2505–2512

    Article  CAS  PubMed  Google Scholar 

  20. Narazaki M, Hagihara K, Shima Y, Ogata A, Kishimoto T, Tanaka T (2011) Therapeutic effect of tocilizumab on two patients with polymyositis. Rheumatology (Oxford) 50:1344–1346

    Article  Google Scholar 

  21. Higgs BW, Zhu W, Morehouse C et al (2014) A phase 1b clinical trial evaluating sifalimumab, an anti-IFN-alpha monoclonal antibody, shows target neutralisation of a type I IFN signature in blood of dermatomyositis and polymyositis patients. Ann Rheum Dis 73:256–262

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Iannone F, Lapadula G (2012) The inhibitor of costimulation of T cells: abatacept. J Rheumatol Suppl 89:100–102

    Article  CAS  PubMed  Google Scholar 

  23. Musuruana JL, Cavallasca JA (2011) Abatacept for treatment of refractory polymyositis. Joint Bone Spine 78:431–432

    Article  PubMed  Google Scholar 

  24. Arabshahi B, Silverman RA, Jones OY, Rider LG (2012) Abatacept and sodium thiosulfate for treatment of recalcitrant juvenile dermatomyositis complicated by ulceration and calcinosis. J Pediatr 160:520–522

    Article  PubMed Central  PubMed  Google Scholar 

  25. Murata K, Dalakas MC (1999) Expression of the costimulatory molecule BB-1, the ligands CTLA-4 and CD28, and their mRNA in inflammatory myopathies. Am J Pathol 155:453–460

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Nagaraju K, Raben N, Villalba ML et al (1999) Costimulatory markers in muscle of patients with idiopathic inflammatory myopathies and in cultured muscle cells. Clin Immunol 92:161–169

    Article  CAS  PubMed  Google Scholar 

  27. the U.S. National Institutes of Health: ClinicalTrials.gov. Available at: www.clinicaltrials.gov. Accessed 23 Dec 2013

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Disclosures

MK has attended several rheumatologic congresses and meetings by sponsorship from AbbVie, BMS, Pfizer, MSD, Roche and UCB. MK is a member of the advisory boards of AbbVie, BMS, Pfizer, MSD, Roche and UCB. AK has no disclosures.

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Correspondence to Markku J. Kauppi.

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Kerola, A.M., Kauppi, M.J. Abatacept as a successful therapy for myositis—a case-based review. Clin Rheumatol 34, 609–612 (2015). https://doi.org/10.1007/s10067-014-2507-4

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  • DOI: https://doi.org/10.1007/s10067-014-2507-4

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